What Is Heart Valve Replacement?

Four valves regulate blood flow in your heart. If a valve is damaged from disease or injury, it may need to be replaced, often with minimally invasive surgery.

The normal human heart has four chambers, two in the upper part of the heart (the atria) and two in the lower chambers (the ventricles). As your heart muscle contracts and relaxes, a valve in each of the chambers opens, letting blood flow into the ventricles and atria at alternate times, then closes to keep blood from flowing backwards.

Obviously, normal heart valves play an important role in circulating blood through the heart and the rest of your body. But if a valve isn’t working properly — and heart function is significantly compromised — serious health problems can develop, and valve replacement may be necessary, the Centers of Disease Control and Prevention (CDC) explains.

Valve replacement surgery can improve quality of life and, in many cases, save lives. However, any kind of surgery involving the heart can seem daunting and downright frightening.

But there’s good news for many heart patients with faulty heart valves: Technological advances have led to new techniques that are minimally invasive and greatly lessen the risks of heart surgery to replace damaged heart valves.

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Understanding how heart valves function

Each of the four valves in your heart plays a specific role in how blood moves into and out of your heart, the American Heart Association (AHA) points out

The aortic and mitral valves control the flow of oxygen-rich blood from the lungs to the body. The aortic valve separates the left ventricle (in the lower part of your heart) from the largest blood vessel in your body — the aorta — that transports oxygen rich blood from your heart to the rest of your body. It opens so blood can flow through the aorta and closes to keep blood from moving back from the aorta to the left ventricle. The mitral valve separates the left atrium, located in the upper part of your heart, from the bottom left ventricle. When the mitral valve opens, the heart pumps blood through to the left atrium from the lungs. Then the valve closes to keep blood from moving back into the left ventricle.

The tricuspid valve separates the top right chamber (atrium) of your heart from the bottom right chamber (ventricle), opening so blood can flow between these two chambers, from top to bottom, and closing to prevent blood from flowing back up from the right ventricle into the right atrium.

The pulmonary valve is located between the lower right ventricle and the pulmonary artery (which carries deoxygenated blood to the lungs for replenishment with oxygen). It lets blood from the right ventricle flow to the pulmonary artery and into the lungs, where the blood picks up oxygen to deliver throughout the body. Like all the heart valves, the pulmonary valve works much like a one-way door, preventing any back flow of blood from the pulmonary artery into the right ventricle.

If any of these valves cannot open or close normally due to damage or disease, blood flow can be disrupted among areas of the heart. This can sometimes be a relatively minor problem that doesn’t interfere significantly with quality of life. But a significantly leaky or stiff heart valve can cause several potentially serious health problems, ranging from exercise intolerance to life-threatening complications, especially congestive heart failure.

Causes and types of heart valve damage

Causes of valvular heart disease include infections, such as rheumatic heart disease and endocarditis, according to the CDC. Problems requiring valve replacement can also be congenital (present from birth) or may develop as a consequence of advancing age. In addition, a heart attack or long-standing high blood pressure can result in damage to a heart valve.

There are two primary heart valve problems that may require replacement:

• Regurgitation (a leaking heart valve). All normal heart valves have flap-like leaflets that open and close to regulate blood flowing into and away from the heart. Sometimes the valve may be missing a leaflet (most often, in the aortic valve) or it can be floppy (prolapsed) or stiff. When any valve fails to close completely, blood leaks back into the chamber it came from and a normal amount of blood may not be pushed forward through the heart. Doctors hear this regurgitation as a murmur through a stethoscope. Minor regurgitation may not be a problem, but a worsening or significantly leaking valve often needs to be either repaired or replaced.
• Stenosis (a narrowing or stiffening of a heart valve). This condition indicates the opening of a valve is narrowed and stiff. So, the valve is not able to open fully when blood is trying to pass through. Aortic stenosis, a narrowing of the aortic valve opening, is one of the most common and serious valve disease problems. Although a birth defect can cause the condition, it is most often due to aging; over many years, calcium or scarring can damage the valve and restrict blood flow, the AHA explains.

Diagnosing and treating valvular heart disease

Heart valve problems may develop slowly, with few symptoms until the condition is advanced, or valve damage may occur rapidly.

Symptoms of valvular heart disease include:

• Shortness of breath
• Unusual fatigue
• Chest pain
• Fainting or feeling dizzy
• Arrhythmia (irregular heartbeat)
• Rapid, unexplained weight gain

Options for heart valve replacement valves

Depending on the type and severity of valvular heart disease, medication can manage symptoms of the condition. Surgery to replace the valve, however, is often the best treatment.

There are several choices to consider when discussing heart valve options with your doctor. The type of valve and surgical approach used can impact both your short-term recovery and long-term quality of life, the AHA explains.

Types of replacement heart valve options:

• Manufactured mechanical valves. These types of replacement valve will usually last a lifetime. You will likely have to take a blood thinner every day to keep blood clots from forming in the valve’s flap-like hinges.
• Donor valve implants. Human donor valves are expected to last 10 to 20 years.
• Tissue valves. Derived from animal valves or animal tissue, these valves are strong and flexible. They usually need to be replaced in one to two decades.

What is minimally invasive heart valve replacement surgery?

In the past, open heart surgery was the only way to perform heart valve replacement. It is still used in certain cases. But for many heart patients facing valve replacement, minimally invasive procedures can successfully repair and replace heart valves.

These techniques reduce the risks of open heart surgery and have made the option for valve replacements possible for more heart patients than ever before. In fact, over 182,000 heart valve replacements are now performed each year in the U.S., according to data compiled by IData Research.

Although procedures incorporating catheters (long, thin tubes) have been used to diagnose and treat some heart conditions for decades, more recent advancements in imaging techniques — including 3D echocardiography — have expanded ways the catheter technique can be used to repair and replace heart valves.

Although minimally invasive procedures aren’t risk-free, the experience is more comparable to a coronary angiogram than major surgery, and it involves far less time in the hospital than traditional valve surgery, according to the AHA. There is also a lower risk of infection, less trauma to heart muscle tissue and the chest wall, and a far quicker recovery time.

TEER (transcatheter edge to edge repair) is a minimally invasive procedure now widely used to repair a mitral valve. By employing high-tech imaging, a surgeon guides a catheter to the heart, usually through a vein in the leg. Then a small, implanted clip is attached to the mitral valve to help it close more completely, restoring normal blood flow through the heart. A similar procedure can also repair the tricuspid valve.

Even when people have severe aortic stenosis, they may be good candidates for a minimally invasive heart valve replacement called TAVR, which stands for transcatheter aortic valve replacement (also sometimes called transcatheter aortic valve implantation, or TAVI).

In 2019, dramatic and frequently inaccurate headlines proclaimed that Mick Jagger was undergoing heart valve surgery and suggested the aging rocker’s chest was being opened for surgeons to operate directly on his heart. The truth, however, was that the 75- year-old rocker had his damaged heart valve replaced via minimally invasive TAVR. A catheter inserted through a large vein in Jagger’s thigh carried a new replacement aortic valve into his heart, without any incision in his chest at all — and he was back performing on stage in about six weeks.

The bottom line

If you or a family member needs a heart valve replacement or repair, it’s important to remember every heart valve problem must be diagnosed and treated individually. However, depending on a patient’s age, medical history, and current health, your doctor has more options than ever before to find the best surgical option for needed heart valve replacement or repair.

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